Childhood socioeconomic position and adult mental wellbeing: Evidence from four British birth cohort studies

Early Life Disadvantage and the Risk of Depressive Symptoms among Young Black Women

OVERVIEW

We examined the association between early-life socioeconomic disadvantage and depressive symptoms in adulthood and assessed whether social factors in adulthood modify the association.

METHODS

The 11-item Center for Epidemiologic Studies-Depression Scale (CES-D) assessed adult depressive symptoms among 1612 Black women and other participants with a uterus (hereafter participants) in the Study of Environment, Lifestyle and Fibroids. Baseline self-reported childhood factors (i.e., parents in the household, mother's educational attainment, food insecurity, neighborhood safety, childhood income, and quiet bedroom for sleep) were included in a latent class analysis to derive an early life disadvantage construct. Multivariable log-binomial models estimated the association between early life disadvantage and adult depressive symptoms. Potential effect modifiers included adult educational attainment, social support, and financial difficulty.

RESULTS

Participants classified as having high early life disadvantage had 1.34 times (95% CI: 1.20, 1.49) the risk of high depressive symptoms than those in the low early life disadvantage class after adjusting for age, first born status, and childhood health. Adult educational attainment and social support modified the association.

CONCLUSION

Early life disadvantage increased the risk of depressive symptoms in adulthood. Participants with at least some college education and with high social support had greater risk than those with less than college education and low social support, respectively. Thus, the mental health of Black women and other participants with a uterus exposed to early life disadvantage do not necessarily benefit from higher education or from social support.

Predicting depression in old age: Combining life course data with machine learning

With ageing populations, understanding life course factors that raise the risk of depression in old age may help anticipate needs and reduce healthcare costs in the long run. We estimate the risk of depression in old age by combining adult life course trajectories and childhood conditions in supervised machine learning algorithms. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we implement and compare the performance of six alternative machine learning algorithms. We analyse the performance of the algorithms using different life-course data configurations. While we obtain similar predictive abilities between algorithms, we achieve the highest predictive performance when employing semi-structured representations of life courses using sequence data. We use the Shapley Additive Explanations method to extract the most decisive predictive patterns. Age, health, childhood conditions, and low education predict most depression risk later in life, but we identify new predictive patterns in indicators of life course instability and low utilization of dental care services.

Lower socio-economic status in adolescence is associated with poor oral health at an older age: Mediation by social and behavioural factors

AIM

To examine the mediators between lower socio-economic status (SES) in adolescence and oral health at an older age to uncover the underlying mechanisms of the association.

METHODS

Participants (n = 21 536) aged ≥65 years from the Japan Gerontological Evaluation Study were evaluated. The dependent variables were self-rated chewing difficulty and having ≤19 remaining teeth. The main independent variable was self-perceived SES in adolescence. The Karlson-Holm-Breen method was used for mediation analysis.

RESULTS

Mean age of the participants was 74.8 years (standard deviation = 6.4), and 51.5% were female. Overall, 5598 (26.0%) participants reported chewing difficulty and 9404 (43.7%) had ≤19 remaining teeth. Lower SES in adolescence was associated with a higher prevalence of chewing difficulty (odds ratio [OR] = 1.38, 95%confidence interval [CI] = 1.29-1.48; total effect). After controlling for mediators, OR for lower SES in adolescence was 1.22 (95%CI = 1.13-1.30; direct effect) and 1.13 (95%CI = 1.11-1.16; indirect effect). Mediators, prominently the number of teeth and income, explained 39.3% of the associations. Lower SES in adolescence increased the odds of ≤19 remaining teeth by OR = 1.23 (95% CI = 1.16-1.31; total effect). After controlling for mediators, the OR for lower SES in adolescence was 1.03 (95%CI = 0.97-1.10; direct effect) and 1.19 (95%CI = 1.16-1.23; indirect effect). Mediators, prominently educational attainment, explained 85.0% of the associations.

CONCLUSIONS

Lower SES in adolescence was associated with poor oral health at an older age through mediators. Approaches that consider social determinants from the beginning of the life course are required.

Educational attainment and emotional well-being in adolescence and adulthood

Education has been conceptualized as a causal factor leading to emotional well-being. However, it is also possible that some of the effect of education may be due to selection factors. Analyzing data from the National Longitudinal Study of Adolescent to Adult Health (n = 10,908), we asked: to what extent does educational attainment increase emotional well-being once stable observed and unobserved individual characteristics are accounted for? Findings from fixed effects models showed that attaining a college degree was associated with greater emotional well-being. However, interactions with gender indicate that the positive association with emotional well-being is primarily for women, although a small negative association between completing college and depressive affect was found for men. These findings point to unmeasured confounding factors as motivating some of the association between educational attainment and emotional well-being among adolescents and adults.

Estimating the Impact of Relative Financial Circumstances in Childhood on Adult Mental Wellbeing: a Mediation Analysis

Previous research has indicated that the role of childhood circumstances on adult mental health is primarily mediated through adult socioeconomic circumstances. Using linear regression models and mediation analysis this paper examines whether childhood financial circumstances is associated with adult mental wellbeing and to what extent any association is explained by adult financial circumstances. Adjusting for age and highest education attainment, we found that childhood financial circumstances predict wellbeing in adulthood. However, stratifying by age (respondents aged 18-40, 41-65 and 66 years plus), a more complicated pattern of associations emerged with potential cohort and age effects emerging. Only adult financial circumstances significantly impact adult wellbeing in our youngest group, while neither childhood nor adult financial circumstances are significantly associated with wellbeing in the oldest age group (66 years plus). However, both childhood and adult financial circumstances were significantly associated with wellbeing in middle age, and this effect was mostly direct (OR-1.09: CI 95%: -1.63, -0.17) rather than indirect (OR-0.08: CI 95%: -0.17, -0.01). This research adds to the evidence base that childhood is a critical period for wellbeing in middle age (41-65 years). Previous research has found that subjective wellbeing plays an important role in physical and mental health outcomes in adulthood. The impact of financial hardship in childhood on wellbeing in adulthood found in this study is particularly concerning as levels of child poverty increase in the UK.

Benefits of Bullying? A Test of the Evolutionary Hypothesis in Three Cohorts

Recent work on bullying perpetration includes the hypothesis that bullying carries an evolutionary advantage for perpetrators in terms of health and reproductive success. We tested this hypothesis in the National Child Development Study (n = 4998 male, n = 4831 female), British Cohort Study 1970 (n = 4261 male, n = 4432 female), and TRacking Adolescents' Individual Lives Survey (n = 486 male, n = 521 female), where bullying was assessed in adolescence (NCDS, BCS70: age 16, TRAILS: age 14) and outcomes in adulthood. Partial support for the evolutionary hypothesis was found as bullies had more children in NCDS and engaged in sexual intercourse earlier in TRAILS. In contrast, bullies reported worse health in NCDS and BCS70.

Risk factors relate to the variability of health outcomes as well as the mean: A GAMLSS tutorial

Background:

Risk factors or interventions may affect the variability as well as the mean of health outcomes. Understanding this can aid aetiological understanding and public health translation, in that interventions which shift the outcome mean and reduce variability are typically preferable to those which affect only the mean. However, most commonly used statistical tools do not test for differences in variability. Tools that do have few epidemiological applications to date, and fewer applications still have attempted to explain their resulting findings. We thus provide a tutorial for investigating this using GAMLSS (Generalised Additive Models for Location, Scale and Shape).

Methods:

The 1970 British birth cohort study was used, with body mass index (BMI; N = 6007) and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale; N = 7104) measured in midlife (42–46 years) as outcomes. We used GAMLSS to investigate how multiple risk factors (sex, childhood social class, and midlife physical inactivity) related to differences in health outcome mean and variability.

Results:

Risk factors were related to sizable differences in outcome variability—for example males had marginally higher mean BMI yet 28% lower variability; lower social class and physical inactivity were each associated with higher mean and higher variability (6.1% and 13.5% higher variability, respectively). For mental wellbeing, gender was not associated with the mean while males had lower variability (–3.9%); lower social class and physical inactivity were each associated with lower mean yet higher variability (7.2% and 10.9% higher variability, respectively).

Conclusions:

The results highlight how GAMLSS can be used to investigate how risk factors or interventions may influence the variability in health outcomes. This underutilised approach to the analysis of continuously distributed outcomes may have broader utility in epidemiologic, medical, and psychological sciences. A tutorial and replication syntax is provided online to facilitate this (https://osf.io/5tvz6/).

Funding:

DB is supported by the Economic and Social Research Council (grant number ES/M001660/1), The Academy of Medical Sciences / Wellcome Trust (“Springboard Health of the Public in 2040” award: HOP001/1025); DB and LW are supported by the Medical Research Council (MR/V002147/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Objective and subjective childhood socioeconomic disadvantage and incident depression in adulthood: a longitudinal analysis in the Sister Study

Understanding of the role of objective versus subjective childhood socioeconomic disadvantage (SD) in depression onset in adulthood among women, independent of later life SD, and across birth cohorts, is limited. We examined the association between objective (i.e., household education level) and subjective (i.e., rank of family income and report of not enough food to eat) SD during childhood and diagnosis of clinical depression after age 30 among 47,055 women in the Sister Study. We used Cox proportional hazard models adjusting for women's race/ethnicity, childhood household composition, mother's age at her birth adulthood educational attainment, and calendar year of birth. Analyses were repeated stratified by 10-year birth group. A total of 8036 (17.1%) women were diagnosed with clinical depression over a mean follow-up of 24.0 (± 9.9) years. Those reporting being poor (versus well-off) or not having enough food to eat in childhood had a 1.28 (95% confidence interval (CI) 1.13, 1.44) and 1.30 (95% CI 1.21, 1.41) times higher rate of depression diagnosis, respectively, with consistent associations observed across birth year groups. An inverse association between low household education level and incident depression was observed at baseline (i.e., age 30) becoming positive over time in the total sample but only among women born between 1935-1954 in analyses stratified by 10-year birth group. Our findings suggest that subjective SD in childhood is a largely consistent predictor of depression onset among women in adulthood whereas the effects of household education level in childhood may vary across women born into different birth cohorts, and for some, across the lifecourse.

Childhood correlates of adult positive mental well-being in three British longitudinal studies

BACKGROUND

Previous evidence has shown how experiences within childhood, such as parenting and socioeconomic conditions, are associated later on in life with adult mental well-being. However, these studies tend to focus on childhood experiences in isolation, and fewer studies have investigated how multiple aspects of the childhood environment, including both socioeconomic and psychosocial aspects, are associated with adult positive mental well-being. Using data from three British birth cohort studies, we investigated how prospective measures of the childhood environment up to the age of 16 years were associated with midlife adult mental well-being and whether similar associations were replicated across different generations.

METHODS

Childhood environment comprised socioeconomic circumstances, psychosocial factors (child-rearing and parenting, family instability) and parental health. The Warwick-Edinburgh Mental Wellbeing Scale, a validated instrument measuring both hedonic and eudaemonic aspects of well-being, was administered in mid-life. We modelled associations between childhood environment domains and well-being.

RESULTS

Despite changes in social context in all three studies, poorer quality parent-child relationships and poor parental mental health were strongly and independently associated with poorer adult mental well-being. Socioeconomic circumstances were also associated with adult mental well-being, but the association was weaker than for the measures of parenting or parental mental health.

CONCLUSION

These findings confirm that parenting and parental mental health, as well as socioeconomic circumstances, are important for adult mental well-being. Interventions in early childhood aimed at reducing socioeconomic adversity and offering support to parents might be warranted, to enhance adult mental well-being later on in the life course.

Seeing the Finish Line? Retirement Perceptions and Wellbeing among Social Workers

Planning for future health and social services (HSS) workforces must be informed by an understanding of how workers view their work within the context of their life and the challenges they will face across the course of life. There is a range of policies and provisions that states and organisations can adopt to create sustainable careers, support wellbeing at work, and extend working lives where appropriate, but the potential impact of these policies on the make-up of the workforce remains under investigation. This paper makes the case that service planners need to appreciate complex interplay between wellbeing and career decisions when planning the future workforce. It makes use of a recent survey of United Kingdom (UK) social workers (n = 1434) to illustrate this interplay in two ways. First, we present the analysis of how social workers' perception of retirement and extended working lives are associated with dimensions of Work-Related Quality of Life (WRQL). We find that social workers who agreed that a flexible working policy would encourage them to delay their retirement scored lower on the Home-Work Interface and Control at Work dimensions of WRQL, while social workers who indicated a perception that their employer would not wish them to work beyond a certain age had lower Job and Career Satisfaction scores. Second, we propose a new typology of retirement outlooks using latent class analysis of these attitudinal measures. An 8-class solution is proposed, and we demonstrate the predictive utility of this scheme. Results are discussed in terms of the challenges for ageing Western populations and the usefulness of analysis such as this in estimating the potential uptake and impact of age-friendly policies and provisions.

Exploring the role of early-life circumstances, abilities and achievements on well-being at age 50 years: evidence from the 1958 British birth cohort study

OBJECTIVES

We aim to examine the relative contributions of pathways from middle childhood/adolescence to mid-life well-being, health and cognition, in the context of family socio-economic status (SES) at birth, educational achievement and early-adulthood SES. Our approach is largely exploratory, suspecting that the strongest mediators between childhood circumstances and mid-life physical and emotional well-being may be cognitive performance during school years, material and behavioural difficulties, and educational achievement. We also explore whether the effects of childhood circumstances on mid-life physical and emotional well-being differ between men and women.

SETTING/PARTICIPANTS

Data were from the National Child Development Study, a fully-representative British birth cohort sample of 17 415 people born in 1 week in 1958.

PRIMARY/SECONDARY OUTCOME MEASURES

Our four primary mid-life outcome measures are: cognitive performance, physical and emotional well-being and quality of life. Our intermediate adult outcomes are early-adulthood social class and educational/vocational qualifications.

RESULTS

Using structural equation modelling, we explore numerous pathways through childhood and early adulthood which are significantly linked to our outcomes. We specifically examine the mediating effects of the following: cognitive ability at ages 7, 11 and 16 years; childhood psychological issues; family material difficulties at age 7 years: housing, unemployment, finance; educational/vocational qualifications and social class position at age 42 years.We find that social class at birth has a strong indirect effect on the age 50 outcomes via its influence on cognitive performance in childhood and adolescence, educational attainment and mid-life social class position, together with small direct effects on qualifications and social class position at age 42 years. Teenage cognitive performance has a strong positive effect on later physical health for women, while educational/vocational qualifications have a stronger positive effect on emotional well-being for men.

CONCLUSION

Our findings provide an understanding of the legacy of early life on multiple aspects of mid-life health, well-being, cognition and quality of life, showing stronger mediated links for men from childhood social class position to early adult social class position. The observed effect of qualifications supports those arguing that education is positively associated with subsequent cognitive functioning.

Association of Borderline Intellectual Functioning and Adverse Childhood Experience with adult psychiatric morbidity. Findings from a British birth cohort

BACKGROUND

To examine whether Borderline Intellectual Functioning (BIF) and Adverse Childhood Experiences independently predict adult psychiatric morbidity.

METHODS

We performed a secondary analysis of longitudinal data derived from the 1970 British Birth Cohort Study to examine whether BIF and Adverse Childhood Experiences independently predict adult mental distress as measured by the Malaise Inventory. Factor analysis was used to derive a proxy measure of IQ from cognitive testing at age 10 or 5. Variables that could be indicators of exposure to Adverse Childhood Experiences were identified and grouped into health related and socio-economic related adversity.

RESULTS

Children with BIF were significantly more likely than their peers to have been exposed to Adverse Childhood Experiences (BIF mean 5.90, non-BIF mean 3.19; Mann-Whitney z = 31.74, p < 0.001). As adults, participants with BIF were significantly more likely to score above the cut-off on the Malaise Inventory. We found statistically significant relationships between the number of socio-economic Adverse Childhood Experiences and poorer adult psychiatric morbidity (r range 0.104-0.141, all p < 001). At all ages the indirect mediating effects of Adverse Childhood Experiences were significantly related to adult psychiatric morbidity.

CONCLUSIONS

The relationship between BIF and adult psychiatric morbidity appears to be partially mediated by exposure to Adverse Childhood Experiences. Where possible, targeting Adverse Childhood Experiences through early detection, prevention and interventions may improve psychiatric morbidity in this population group.

Associations between birth order with mental wellbeing and psychological distress in midlife: Findings from the 1970 British Cohort Study (BCS70)

BACKGROUND

Previous research indicated that birth order was associated with physical health outcomes in adulthood. However, evidence on its association with mental health was lacking. The aim of this study was to investigate if birth order was associated with mental wellbeing and psychological distress at mid-life, stratified by gender, and taking into account confounding factors in childhood and adulthood.

METHOD

The sample consisted of 9,354 participants of the 1970 British Cohort Study (BCS70). The Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), the Malaise Index and attending a doctor's consultation in the past year for a mental health issue at age forty-two were used to assess mental wellbeing and psychological distress in midlife. Birth order was ascertained via a parental questionnaire and referred to the numerical birth position of the participants. The associations between birth order, mental wellbeing and psychological distress were tested using linear and logistic regression adjusting for birth characteristics: smoking during pregnancy, maternal age, mother's marital status, father's employment, region of birth, parental years of education and parental social class, and factors at age 42: years of education, employment status and partnership status. Potential mediating variables including breastfeeding and birthweight at birth and parental separation and conduct disorder measured at age ten were also taken into account.

RESULTS

We find no evidence to support an association between birth order and midlife psychological distress or attending a doctor's consultation in both men and women. In unadjusted analysis, there was an association between birth order four and above and a reduced WEMWBS score of -0.79 (95% CI -1.57, -0.02) in men only. This association was attenuated after adjusting for birth characteristics and mediators at birth (0.86, 95% -1.78, 0.07) but was maintained once conduct disorder at age 10 was accounted for (-1.19, 95% CI -2.28, -0.09). However, this association was attenuated once again after adjusting for employment status, years in education and partnership status in adulthood (-1.04, 95% CI -2.11, 0.03).

CONCLUSIONS

In this study, birth order was not associated with psychological distress or having a mental health issue at midlife. Accounting for employment status, years of education and partnership status in adulthood attenuated the relationship between birth order and mental wellbeing.

Associations of childhood health and financial situation with quality of life after retirement - regional variation across Europe

Many studies have shown that childhood circumstances can have long term consequences that persist until old age. To better understand the transmission of early life circumstances, this paper analyses the effects of health and financial situation during childhood on quality of life after retirement as well as the mediating role of later life health, educational level, and income in this association. Moreover, this study is the first to compare these pathways across European regions. The analyses are based on data of 13,092 retirees aged ≥ 60 and ≤ 85 years from the fifth wave of the Survey of Health, Aging, and Retirement in Europe (SHARE) with full information on childhood and later life measures of health, educational level, financial situation, and quality of life as well as relevant covariates. Five European regions are studied: Central-Western Europe (Austria, Germany), Central-Eastern Europe (Czech Republic, Estonia, Slovenia), Northern Europe (Denmark, Sweden), Southern Europe (Italy, Spain), and Western Europe (Belgium, France, The Netherlands). Path analysis is used to identify the direct and indirect effects of childhood measures on quality of life. We find retirees' quality of life to be associated with childhood finances and health in all five European regions. While both the direct and indirect effects of childhood health are rather moderate and homogeneous across regions, especially the direct effects of childhood finances on quality of life after retirement display a distinct North-South gradient being strongest in Southern Europe. Potential explanations for the regional variations are differences in the countries' welfare systems.

Do psychosocial job stressors influence mental health service use? Evidence from an Australian cohort

OBJECTIVES

There is strong evidence of a relationship between psychosocial job stressors and mental health at the population level. There has been no longitudinal research on whether the experience of job stressors is also associated with greater mental health service use. We seek to fill this gap.

METHODS

The Household Income Labour Dynamics in Australia survey cohort was used to assess the relationship between exposure to self-reported psychosocial job quality and reporting attendance at a mental health professional during the past 12 months. We adjusted for time-varying and time-invariant confounders. The study was conducted in 2009 and 2013.

RESULTS

In the random effects logistic regression model, increasing exposure to psychosocial job stressors was associated with an increased odds of mental health service use after adjustment (one stressor: OR 1.26, 95% CI 1.01 to 1.56; two stressors: OR 1.33, 95% CI 1.02 to 1.73; three stressors: OR 1.82, 95% CI 1.28 to 2.57). However, once the between person effects were controlled in a fixed effects model, the within-person association between change in job stressors and change in mental health service use was estimated to be close to zero and not significant.

CONCLUSIONS

More work is needed to understand the relationship between job stressors and service use. However, when taken with past findings on job stressors and mental health, these findings highlight the importance of considering policy and clinical practice responses to adverse working contexts.

Capturing the diversity of working age life-courses: A European perspective on cohorts born before 1945

Life-courses describe people's activities from the cradle to the grave. Because life-courses are typically complex, models are used to simplify their description. The most commonly used model is tripartite, representing lives in subsequent periods of education, work, and retirement. However, researchers criticize this model as limited in the activities considered, overly simplistic in the activity sequence, and blind to variation between life-courses. This article explores working age life-courses, which typically show high diversity. Multichannel sequence and cluster analyses are conducted on people's activities from age 15 to 65. Data stem from the life-history interviews of the Survey of Health, Ageing and Retirement in Europe, capturing cohorts born before 1945. Findings show that three out of four working age life-courses are in line with the tripartite model. This share is particularly high among men, the cohort born 1935 to 1944, and in Northern and Eastern Europe. In contrast, a considerable share of women spent their working age on homemaking, especially women born before 1935, and those living in Southern Europe. Finally, a smaller number of men spent their working age on paid work, followed by a period of illness or of non-employment. The working age life-course patterns identified are used to develop alternative life-course models. However, for a parsimonious solution, the use of two models suffices. A combination of the tripartite model and the model equating middle age to homemaking captures the lives of more than nine out of ten older Europeans. The prevalence of working age life-course patterns in a population is country-specific, and the country differences align with the welfare regimes. This perspective makes working age life-courses characteristics of a society that can be used to map social inequalities at the macro-level and capture social change over time.